Provider First Line Business Practice Location Address:
4645 RUFFNER ST STE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-489-3197
Provider Business Practice Location Address Fax Number:
619-489-3197
Provider Enumeration Date:
04/27/2026